Formula for survival

Medical nutrition therapy helps save lives

Linda Herrero's blue backpack is sturdy and capacious, but she never uses it to lug books or stash her pens inside. Instead, the 14-year-old keeps her lunch--a clear plastic IV bag filled with a milky white liquid--inside, along with a programmable pump that drips a sterilized meal straight into her bloodstream.

Like thousands of others who can't take their food by mouth for various medical reasons, the Salinas eighth grader relies on a carefully balanced feeding formula to meet all her body's dietary needs. Offering 1,100 calories and all the vitamins, minerals and calories Herrero needs, the custom made and home-delivered formula keeps her out of the hospital and in school even through her intestines can't absorb nutrients.

Managing disease through nutrition is hardly a new concept; healers in most cultures have long relied on special foods to fortify their patients. But today, the science of nutrition has progressed to the point where, like medical treatments and prescription drugs, nutrition therapy can be used to treat diseases such as HIV/AIDS, cancer, kidney disease, heart disease, diabetes and sever burns.

"It's become a more clinically accepted field," says Gwen Porter, the registered dietician who oversees Herrero's nutrition therapy. "More physicians are accepting that it plays a part in meeting a patient's needs."
In Herrero's case, nutrition therapy has helped save her life.

When she developed the infection that left her unable to digest food last year, Herrero lost 10 of her already insubstantial 85 pounds. Her worried doctor prescribed nutrition therapy to restore Herrero's strength.

Today, Herrero wears about five inches of clear plastic tubing taped to her sternum. Inside her body, the line is connected to the subclavian vein that runs beneath the clavicle. The vein is one of the few large enough to carry a thick nutrition solution without bursting.

"I was scared when they first told me they were going to put it on," Herrero says. "I was crying that I didn't want it. But my godmother talked to me and said why it's going to be better for me."

She understands now why the line is so important. "If I don't have this on my body, I wouldn't stay up."

Herrero has since rebounded to her original weight by wearing the pump 16 hours a day, starting in the afternoon when she returns from school. Godmother Leticia Acona, who has cared for Herrero since infancy, connects the IV bag to the pump.

"I get scared doing it myself," Herrero explains.

Herrero puts the bag on the floor while she sleeps and can even stay hooked up to the pump in the shower. These days, she's so accustomed to wearing the apparatus that "sometimes I forget I have it in. I want to run and I feel a tug," Herrero says. "the line has told me I can't go and I have to go back and get my backpack."

Although the bulky bag of liquid and the several feet of trailing lines can cramp Herrero's playing style, the intravenous connection has its advantages. For one thing, Herrero can just offer up the tube instead of suffering a needle stick when it's time to give the weekly blood sample used to adjust the formula recipe. The line also offers an easy route to administer medication; many drugs can be dripped straight into the line.

Herrero has even devised a way to use her dietary distinctiveness as a source of amusement. When a skinny cousin asked what the IV apparatus was for, "I told her, we're going to put you on this because you're not eating. She said, 'I'm going to eat! I'm going to eat!'"

Medically speaking, adequate nutrition is a vital component of a speedy recovery.

"During a severe illness, the body metabolizes everything at a higher rate, and burns protein faster than it burns fat," Porter says. "When you're losing your protein stores, that's your immune system." Because the body's need for recovery calories is so strong, a sick person's body may even metabolize and shrink the heart muscle.

"You never make up for the muscle you lost, and the point of nutrition therapy is to prevent that from happening," Porter says.

Ten years ago, says Porter, people on radiation therapy for cancer in the chest or abdomen "may not have eaten well for five months ... Sometimes the therapy for cancer is as hard on the body as the cancer itself. There's no reason for you to be severely malnourished on top of that."

She says some patients undergoing radiation therapy for chest or abdominal cancers even have feeding tubes inserted directly into the stomach or intestine before the therapy starts. The surgery helps ensure patients maintain their strength throughout the course of treatment.

The types of patients nutrition therapy can help treat also includes those who have had strokes and can no longer swallow; people with bowel or digestive problems; and pregnant women suffering from morning sickness so severe that they can't keep any food down. Dietary counseling for diabetics also falls under the nutrition therapy rubric.

Several studies have concluded that medical nutrition therapy can save millions of health care dollars by preventing the onset of illnesses like diabetes and speeding recovery. But the services of registered dieticians with the expertise to administer the treatment are generally not covered by insurance plans. Medicare rules were written when the science of nutrition therapy was still in its infancy.

Porter says that her employer, AdvantaCare Infusion, which provides nutrition therapy to residents of the Central Coast, is not reimbursed for her professional services by Medicare and must instead shoulder her salary alongside other costs of doing business.

A bill aiming to correct that oversight, cosponsored by Rep. Sam Farr (D-Carmel), is now before Congress. If passed, the Medicare Medical Nutrition Therapy Act of 1999 would offer Medicare coverage for medical nutrition therapy services provided by a registered dietician.

--Kathleen M. Wong